Abstracts: CLINICAL VIGNETTES/CASE REPORTS - STOMACH
Antral Hyperplastic Polyp Causing Gastric Outlet Obstruction: Case Report and Review of Literature
Introduction: The prevalence of gastric polyps ranges from 0.75 to 7%. They are usually asymptomatic with fundic gland polyps being the most common. The incidence of hyperplastic gastric polyps is decreasing due to increasing detection and eradication of Helicobacter pylori. We report a rare case of gastric outlet obstruction (GOO) due to a large prolapsing hyperplastic antral gastric polyp.
Case Report: A 65-year-old male with cirrhosis due to chronic hepatitis C presented to our clinic with symptoms of intermittent nausea, vomiting and abdominal bloating. Upper endoscopy was performed and showed a large 2.5 cm sessile antral polyp lodged in the bulb of the duodenum obstructing the pylorus. The polyp could be gently coaxed out into the antrum with a biopsy forceps. Biopsies were taken and were consistent with hyperplastic polyp with focal ulceration. A subsequent endoscopic ultrasound confirmed a 2.5 cm oval hypoechoic and heterogeneous mass with irregular but well demarcated margins arising from the deep mucosal layer. No adjacent lymphadenopathy was seen. Two cc of 1:10,000 epinephrine was injected at the base of the polyp and the entire polyp was removed with hot snare polypectomy. Prophylactic clips were applied to close the polypectomy defect. Histology showed hyperplastic changes and mucosal ulceration with reactive/reparative atypia. The patient’s symptoms resolved after removal of polyp.
Discussion: Hyperplastic gastric polyps are epithelial proliferations that mainly occur in the antrum. While most are asymptomatic some may present with abdominal pain, iron deficiency anemia or in rare instances GOO. However, fibroid polyps are the most common polyps causing obstruction. If a prolapsed polyp has functional antral mucosa, it might keep secreting gastrin since it is in alkaline medium and may lead to erosion causing iron deficiency anemia. Malignant transformation is rare but the risk may be higher in polyps more than 2 cm in size. Cases of p53 protein over expression in the hyperplastic polyps and increase in Ki 67 labeling indices have been reported indicating increased proliferating activity. These observations could suggest dysplasiacarcinoma sequence in hyperplastic polyps and argue for either complete eradication or at least close surveillance in these patients, especially in polyps > 2 cm in size even in the absence of symptoms.© The American College of Gastroenterology 2014. All Rights Reserved.